Travellers’ Diarrhoea

Really common problem! - 20% of travellers to high-risk countries suffer diarrhoea at some point.

Travellers’ diarrhoea (TD) can be caused by food and water contaminated by most commonly bacteria, but also viruses or protozoa. Diarrohoea often occurs due to lower food hygiene standards and inadequate sanitation facilities.  

Risk factors

Location -high-risk areas are most of Asia, Africa, the Middle East and Latin America. May be seasonal.

Choice of place to eat - the most significant risk factor for TD, particularly relevant in young travellers, teenagers and backpackers.

Activities TD can be contracted from water based activities in infected water such as the sea, lakes or swimming pools.

Age Some travellers will be more unwell and more likely to need treatment or even hospitalisation. The elderly and frail and very young will be at greater risk.

General health - existing medical conditions may put people at greater risk from the effects of travellers diarrhoea. For example, inflammatory bowel disease, chronic heart or kidney disease, immunosuppressed, diabetes and pregnanct women.

Medication may not be absorbed properly. This may impact contraception, antimalarials as well drugs for other medical conditions.

Symptoms

Other symptoms -vomiting, nausea, cramps and fever. Usually self limiting lasting 3-4 days and typically occurs in first week. Can last for over a month and cause irritable bowel syndrome.

Severe symptoms high fever, dehydration, blood or mucous in stool (dysentery) - SEEK MEDICAL HELP

Diagnosis and treatment

Definition of travellers diarrhoea 3 or more unformed stools in 24 hours. Usually is self limiting but if ongoing or severe symptoms then seek medical assistance for tests and management.

Aim of treatment avoid dehydration, reduce duration and frequency of symptoms and minimise the impact on holiday plans.

Rehydration is key - Healthy adults - most can manage mild symptoms with normal food and drinks.

Groups at higher risk from dehydration including the young, old and those with certain medical conditions, or those with moderate / severe symptoms should use oral rehydration powders in clean water or a salt/sugar mix (1 litre safe water / 6 level teaspoons of sugar / 1 level teaspoon of salt). It made aid gut recovery to eat small amounts of plain foods like rice or bananas.

Children and infants continue usual diet and breastfeeding should continue for infants.

Anti-diarrhoea medication – or not! The debate continues. about the use of medication to stop diarrhoea .

Consider taking medication if mild symptoms or if diarrhoea very inconvenient, eg travelling on public transport. NEVER use if symptoms severe or if you suffer from inflammatory bowel disease.

Loperamide (for age >12years) and bismuth subsalicylate (age >16years) can be used for mild symptoms and be bought over the counter.

Antibiotics – Generally only when the organism causing the diarrhoea has been identified. Standby antibiotics could be carefully considered in high risk groups or if travelling very remote. Medication recommended for adults would be azithromycin 500mg once a day for 1-3 days.

Medical Assistance – seek medical assistance if TD continues for more than 3 days or IMMEDIATELY if fever over 38 degrees, blood, mucus or other worrying signs like altered mental state, rash, jaundice or severe abdominal cramps. With those travellers who are at higher risk medical attention should be sought earlier, especially if dehydrated or if not managing to drink fluids.

Travellers should follow the FOOD AND WATER ADVICE information and HAND HYGIENE ADVICE.

Reference and for further information

https://travelhealthpro.org.uk/factsheet/53/travellers-diarrhoea